Researchers at Mass General Brigham, a hospital in Massachusetts, found that patients with limited English proficiency (LEP) admitted with Covid-19 had worse clinical outcomes during the first wave of the pandemic. However, outcomes improved during the second wave, demonstrating that efforts to minimize language-based healthcare disparities may have been effective.

The study, “Is the Gap Closing? Comparison of Sociodemographic Disparities in Covid-19 Hospitalizations and Outcomes Between Two Temporal Waves of Admissions,” was published in the February 2022 Journal of Racial and Ethnic Health Disparities.

The researchers, led by general internist and population health specialist, Priscilla Wang, MD, followed almost 10,000 patients hospitalized with Covid-19 during two distinct waves.

In the early phase of the pandemic (March 1–August 31, 2020), the proportion of LEP patients admitted to hospital increased almost fourfold — from 7.7% in 2019 to 29.7% — dipping slightly to 22.7% during the second wave (September 1–March 1, 2021).

It was during the first wave that LEP patients had significantly higher odds of severe illness (i.e., 35% greater chance of dying or requiring ICU hospitalization), compared to English-speaking patients. But this correlation was not observed during the second wave.

According to the study, “Non-English-speaking language status independently predicted worse hospitalization outcomes in wave 1, underscoring the importance of targeted and effective in-hospital supports for non-English speakers.”

Language service providers (LSPs) catering to LEP communities and individuals are familiar with the many ways in which language barriers can impact clinical outcomes.

LEP patients, often recent immigrants with a limited understanding of the US healthcare system, may not have access to health materials in their native language. In particular, LEP patients struggled during the first wave of Covid-19 due to infection control measures that prohibited in-person interpreting, and difficulties in hearing or understanding interpreters due to masks or phone-based (OPI) interpretation.

Researchers suggested two reasons for the improved outcomes during the second wave. Increased access to new therapeutics and vaccines may have helped decrease hospitalizations (or the severity of cases) across demographic groups, while certain efforts specific to supporting LEP patients may also have contributed.

These include an increased availability of in-person interpreters; investing in video remote interpreting (VRI) equipment for isolation rooms; and increasing the translation of informational materials into languages commonly spoken by local LEP patients.

Despite the observed improvements in outcomes, the authors cautioned that “now is not the time to let our guard down. The Covid-19 virus may be novel, but the health system needs and inequities it is exposing are likely not.”



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